Blog posts

  • May 10, 2017 10:20 AM | Michael Hamilton (Administrator)

    Personally, I prefer to make my own decisions. I am still angry that Medicare prevented me for keeping the excellent BCBSAL policy I had in force when I reached the age of 65. Instead, I got a letter from Blue Cross about two months before my birthday telling me that if I expected to have health insurance after the first day of my birth month I had better be signing up for Medicare now! (And by the way, we have this great supplemental policy we'd like to sell you...)

    Many years ago, I had the privilege of hearing Princeton economics professor Dr. Uwe Reinhardt speak about the evolution of American health care, and he made more sense than anyone I have heard or read before or since. He is a widely recognized expert on health economics and is very familiar with the systems in other countries.

    More recently, while reading an editorial by Steve Forbes of Forbes Magazine, I followed a link to an excellent article that referred to Dr. Reinhardt's expressed opinions on possible solutions to the dilemma we face in this country. I urge you to follow the link when you have at least 15-20 minutes available, so you can watch the video of Harvard Business School's Regina Herzlinger. It's ten minutes excerpted from a speech that surely last thirty or more minutes, and it is both informative and absolutely hilarious!

    The author, Dr. Reinhardt and the Harvard professor all agree that we should take a closer look at the Swiss system. It fixes another issue that has always bothered me; many of you young folks may not know that employer-paid health insurance was created as a loophole in WWII wage freezes to allow poaching employees. I don't like employers choosing my insurance plan any more than the government.

    The Swiss require that health insurance be sold like homeowners and automobile insurance, with choices left up to the purchaser. Their system subsidizes the poor, covers previously existing conditions, provides for the availability of widely varying benefit packages, and could be easily adapted to adjust for differences in the US economy.

    It seems to me that adopting a modified version of the Swiss system would address address every concern expressed by all effective entities. It would certainly be a vast improvement over ObamaCare, RyanCare & TrumpCare!

    Bookmark this link, and after you read the article and watch the video, let me know what you think.

  • May 08, 2017 9:48 AM | Michael Hamilton (Administrator)

    While the Republicans got a bill through the House with many of the same tactics they deplored when ObamaCare was passed, and we still don't know much about the content, what is clear is that we are going back to the old-fashioned way of passing a bill that seems to have fallen out of fashion.


    The House bill has gone to the Senate, where it will be either modified or replaced, followed by a conference committee comprising members from both sides of the aisle and both houses that are very familiar with the issue. This committee will, presumably, produce a single bill that must be approved by both House and Senate before going to the President for the signature that will make it a law.


    In this process, only one thing is currently clear—nothing will come of it quickly. It will likely take many months, so there is no reason for anyone to panic over the possible affect of included changes.


    It is also clear from the content of the debate over the House version that our little industry is still far from a priority for addressing issues that affect health care. We still have to go make our case—that we can contribute considerable value to the healthcare continuum if treated fairly. We are in a much better position to do that than ever before, and I am confident that we will be successful, but it will take some time to accomplish. You just have to figure out ways to survive until we succeed.


    The assault on our industry has had many casualties, but we also have many members, in and out of competitive bid areas, who have successfully made changes allowing them to do very well in the current market.


    And it is still true that the market is growing at a huge rate that will continue for many years. The demand will be there, and someone will meet it. Why not you?

  • March 12, 2017 1:21 PM | Michael Hamilton (Administrator)

    The mind-boggling debate over "repealing and replacing" the ACA continues to confuse the terms "health care" and "health insurance."


    Whether it's the panelists on Meet the News or HHS Sec. Price, everyone seems to use the terms almost interchangeably, when they actually refer to totally different issues.


    One of the major problems with ObamaCare is the high deductibles on many, if not most, health exchange policies that often prevent folks who clearly have insurance from getting the actual care they need. 


    No one is addressing either the lack of properly distributed physicians and other health care providers that prevents many rural residents from having reasonable, attainable access to the care covered by their insurance, or the existence of incentives and disincentives that affect the care provided by those already in place. Most everyone describes the changes they are promoting as "improving quality while lowering costs" when the far more likely results of those changes would be to ration care.


    In my experience, the quality of care provided in many cases is affected most by the patient's and family member's knowledge and persistence in participating in the decisions made about tests and treatments, or the simple failure, for whatever reason, to follow the orders of providers. Neither of those issues is addressed by changing how insurance coverage is accessed or what it costs.


    As I have often insisted, words have meanings, and if we can't properly frame the debate with a clear understanding of whether we are discussing the availability of insurance coverage or the availability of actual health care, then we are never going to solve the problems of a health care delivery system that is not working very well for many people.

  • February 23, 2017 9:17 AM | Michael Hamilton (Administrator)

    I am convinced beyond any doubt that the HME industry hit rock bottom in 2016 and has begun a move that will bring us as close as we will ever get to the marvelous first ten years of existence. We have never had an HHS Secretary who knows and appreciates our industry like Dr. Tom Price, and all I have heard about the prospective CMS Administrator has been good. The changes CMS has already made or proposed have been encouraging.

     

    Many experts believe that competitive bidding is too entrenched to be replaced right away and steps have been taken to define a clear path for improvements to make it acceptable. If that is what happens, the industry can recover and grow, but I believe it is still possible–even likely–that Dr. Price will find a way to implement the Market Pricing Plan (MPP). CMS has adopted parts of that plan and proposed other changes taken directly from the legislation Dr. Price has introduced. The legislation that allowed the creation of the current “competitive acquisition” program should allow the adoption of the MPP via the creation of new regulations.

     

    Here’s what I believe will happen:

     

    • Secretary Price will freeze rates at January 2016 levels to mitigate further limitations on access and harm to providers.
    • He will direct the CMS Administrator to cause the creation of new regulations that incorporate the principles of the MPP, which will require 60 to 90 days to complete.
    • The proposed rule will be published for notice and comment, which requires another 60 days.
    • Reviewing and responding to the comments will require approximately another 30 days.
    • The new rule creating the MPP will be published with an effective date 60 days from the date of publication.
    • During this process, the CBIC will have been busy vetting prospective bidders and preparing to accept bids under the revised system.
    • The new process will be in place on October 1, 2017, in time to be used to create the fee schedule effective January 1, 2108.

     

    Of course, this is an optimistic view, but also one that can be accomplished if providers continue doing the things that need to be done.

     

    On my first lobbying visits to Washington in 1975, when we introduced ourselves to Congressional staff, the reaction was usually “Oh, you’re one of those rip-off artists!” On recent visits, we have been greeted with respect as part of the solution to ever-increasing health care costs.

     

    That turnaround in our image hasn’t been produced by getting rid of all the bad apples, because the government has remained unwilling to do what the industry has told them was necessary to accomplish that lofty goal.

     

    It has happened because of a lot of hard work, by a lot of volunteers, and the creation and support of organizations with the expertise needed for such accomplishments.

     

    It has happened because providers have supported Medtrade, gaining information unavailable elsewhere to keep up with the products and services that allow operating successful, efficient businesses.

     

    It has happened because providers have supported AAHomecare, an organization that has served so very well as the industry’s voice in Washington, and the member services organizations who have trained and supported providers in so many ways, including the process of grassroots lobbying.

     

    It has happened because providers have supported the local trade associations who have dealt with local issues so effectively and provided the coordination to make grassroots lobbying timely and effective.

     

    The potential for our industry has never been as great. If you want to be a viable part of a dynamic, growing and exciting industry that does well by doing good, go to Medtrade and learn how to be a better and more efficient businessperson with an appropriate product line for your chosen market. Join and support AAHomecare, your local association and one or more member service organizations. Get or stay involved with your Representative and both Senators. And always be willing to give your own time and money to improving the overall health of the industry.

     

    HME is a great place to be today!

  • November 19, 2015 10:34 AM | Michael Hamilton (Administrator)

    Every week we get several calls focused on the same two variations on a theme: we don't have nearly enough ATPs in Alabama, and; patients are often harmed by well meaning but misinformed providers.


    Apparently, the need for relatively complicated wheelchairs far exceeds the number of properly trained people to spec and fit them in a manner that actually meets the patient's needs without exposing them to harm.


    Calls in the first category are divided between those who brag on the number of chairs they are placing and those who have questions about meeting the requirements for licensure in Alabama, so they can provide those needed services.


    Calls in the second category decry the harm a patient suffered because they were placed in the wrong or poorly fitted chair because the provider didn't know any better.


    Now, I'm don't mean to get off on a rant here...I'm not promoting anything (except better patient care), but I hate to think that current Alabama providers can't meet the demand, or even worse, provide products without the trained staff required to do it properly.


    And I'm not suggesting anything except that all members need to examine where you stand on this issue and make proper adjustments to protect or improve your business. Regardless of anything we might do, there is enormous pressure to expand the requirements for credentials, so if you are fitting any kind of wheelchair, you need to recognize the risks and opportunities you face because of the level of staff training.


    Surely you don't want to risk harming a patient, and that's reason enough for more training, but do you know how much additional business is sure to be available if your staff can recognize all the needs of a chair user, and meet them? Do you have a clue how much harm it does to your company's reputation when referral sources even think you misfit or chose the wrong chair for a patient? Do you see the risk of increased competition in your market if you don't have credentialed staff in this arena?


    Things are going to change, and if you expect to stay in the mobility business, you need to be training your involved staff and getting them credentialed. Don't get caught out in the cold when new competition arrives or the requirements for an ATP are greatly expanded!

  • November 03, 2015 12:53 PM | Michael Hamilton (Administrator)

    Last week, I honored the fall tradition of attending our industry's biggest trade show, and it was really tough. Despite having shrunk alarmingly over the years, the show was as good as ever, but this one was the first after losing Ouida, who never missed going with me until she lost her mobility. I got a lot of condolences in person, all of which I appreciated very much, but they opened wounds. In addition, we just lost one the finest people in the industry, whose parties were always one of the biggest parts of the show, and another friend who is pushing 90 and was planning to attend was unable to make the trip. So, despite what we learned and all the friends we did see, it was still kind of a sad week. It was also physically exhausting, making it more difficult to catch up from being gone so long. I'm happy the only trips left on my calendar for this year are to spend Thanksgiving and Christmas with family!

  • June 30, 2015 9:39 AM | Michael Hamilton (Administrator)

    As the effective date for CMS' ridiculous plan to roll out bid rates to rural areas grows closer, we get calls almost every day asking why the association (ADMEA or AAHomecare) hasn't "done something!"


    Let me answer that question for everyone. AAHomecare has been and continues to move heaven and earth every single day, both in Congress and at CMS, to mitigate the pending disaster in any possible way. ADMEA just visited every Alabama member, (although there were only three of us), doing everything we could to find some assistance in getting things changed. Everyone with whom we spoke agreed with our position and "wished there was something they could do" to help us, but none can change the way Congress has worked for a couple of hundred years.


    We are facing a real crisis that will force some very difficult decisions, because most providers with a substantial rural market can't survive the roughly 25% rate reduction coming in January 2016. The question you should be asking yourself, if you are in this group, is "What have I done to keep this from happening?" You have no right to expect anyone else to do it for you, especially if all you do is pay a few lousy bucks in dues and don't even belong to the national association. No one else has as much at stake as you do, and if you are going to rely on government programs for income, especially a significant portion of your income, then you are going to have to devote time and resources to government affairs.


    Does your Representative and their Health LA know you by name? Have you been to the District office during a recess and spoken to them about this or other issues? Do your beneficiaries and their care givers, and your referral sources, know what's coming and how you will handle it? Are you going to refuse to accept assignment and ask new customers to pay in advance? What about existing customers? How can you possibly provide the same levels of service at drastically reduced rates?


    If you can get that message across to all the affected parties and get them calling the delegation, it will become clearer to Congress how many voters will be adversely affected, and that always helps to stir their creativity.


    We will do the research for you, and add the addresses and phone numbers for all District offices to our "Advocacy" page ASAP, and announce when it's done. You start making plans to invest your own time and effort in protecting your business. If you are already doing so, good for you!

  • June 06, 2015 11:19 AM | Michael Hamilton (Administrator)

    Having been cheated out of our legislation, primarily by the abuse of power exhibited by Sen. Cam Ward, we must face the possibility of having to deal with an onslaught of RS audits. We don't consider it likely, as they make much more money on tax audits, and out tax exemptions are still set in stone, but you must be prepared for the worst case scenario in order to be prudent.


    Before going any further, please read this article about a recent class action lawsuit against RS and its parent company. The judge's position on not making any finds that could be used to produce a refund allow RDS to avoid addressing some of the most egregious practices it undertakes daily, but you can still use these illegal practices against them. 


    The first and most important thing to understand is literally not to let them in the door. Most of the auditors really do not have the right to any information about your business; certainly not about your patients. Ask them for credentials, and no matter what they offer, tell them you don't accept the credentials as valid. Ask them for copies of all the contracts or other agreements by which they claim the right to examine your records, including not only the contracts between the company and the taxing authority but between the company and themselves, including all details on any bonuses they may earn. (That violates the Taxpayer Bill of Rights (TBOR)).


    Be assertive but not aggressive! Speak softly and use your best manners. Do not threaten them in any way. Do not refuse to allow them access to records, but insist that such access can only be made after the prove they are entitled to see them. Listen to them rave and rant, if necessary, and every time they do so, when they run out of breath and stop ranting for any length of time, repeat a little more softly what you have already told them. "Before I show you any records, I must see and have my attorney review the basis for the authority you claim." The louder they get, the softer you should speak.


    We trust this will be enough hassle to convince most auditors to seek softer ground to plow, but if it's not, they will most likely go to a supervisor for help. Treat them to the same southern hospitality, including the smiles and soft-spokeness, but be just as firm. You can't show them any records until they have produced the materials requested and your attorney has approved giving them access. This is not, nor is it intended to be legal advice. You are invited to consult your attorney before taking any of the steps described herein. 


    There will be additional information on this subject posted every day or so...

  • April 30, 2015 9:44 AM | Michael Hamilton (Administrator)

    We had hoped to learn how to do everything in the best and most efficient manner after one cycle through each activity, such as a meeting, dues renewal, etc., but it appears that, like most software, there is always more to be learned.


    At least we have finally figured out which buttons to push to make this blog visible, obtained a sponsor, and are making it available to the public, in the hope that it will serve as a recruiting tool.


    We have also learned a better way to offer multiple person discounts for convention registration that has proven to work very well. As the first user said, "It's funny, when you read and follow the directions, it normally goes very smoothly." When you sign up the first person from your company, an email is produced with a discount code for the second and subsequent persons. Use the code(s) to sign up as many as you like before checking out, and you can pay for everyone in one transaction!


    You are welcome to use this blog to comment on or question anything. It will usually be the author's opinion, without any Board approval, and since no one is using the forums, maybe this will suit you better as a means for discussing "is everyone having the same problem?" and "Has anyone figured out how to fix this problem?"


    We may have missed something, but if this works as intended, there will be a comment button on each post. Let me know what you think.

  • February 12, 2015 10:47 AM | Michael Hamilton (Administrator)
    "The GAO suggested that the VA needs to address problems with timeliness and quality of care within the system.

    Other issues for the VA include retaliation against whistle-blowers, poor staff training, undeserved bonuses, and antiquated computer systems, according to auditors.

    “These risks to the timeliness, cost-effectiveness, quality and safety of veterans’ health care, along with persistent weaknesses we have identified in recent years, raises serious concerns about VA’s management and oversight of its health care system,” the GAO said."


    I suppose the best description of the VA health system would be inconsistent. Like any government or private sector business, it has good employees and not-so-good; caring people, and those who are just working for a payday. Over the years, I have known many veterans who claim to have received excellent care at the Birmingham VA Hospital; my own experience indicates otherwise.


    When I was in the home oxygen business in Birmingham, the VA staff was so squirrely that I never tried to do business with them. Later, of course, they demanded outrageous services for low bid rates. As a surveyor for JCAHO, I found them all of the place from city to city, but most were very accomplished at hiding things they didn't want a surveyor to see, and as the Joint Commission's biggest customer, I soon learned that it didn't matter what you turned in; they would be accredited anyway.


    My son did a rotation there while a student at the University of Alabama School of Medicine, and what he found was appalling, very much in line with the recent horror stories that have dominated the news for long periods. I think our 2nd District Representative, Martha Roby, may do more good than anyone ever has. These systemic problems have been well known for ages; no politician has been willing to stay after them long enough to actually accomplish anything. I'm writing about them because we cab use their condition to make a case against low-bid healthcare. Read more here...




Copyright © 2007- 2017
by
Association Services LLC
1405 Old Forest Rd
Birmingham, AL 35243


UsingUsing this site implies consent to the Terms of Use, including the Privacy Policy

Powered by Wild Apricot Membership Software